Headaches

more about Headaches

Description

Headaches come in many varieties, all of which have symptoms that may vary slightly from one another. Primary headaches (including migraines, Cluster Headaches and tension-type of headaches) are a result of neurochemical changes within the nervous system. Secondary headaches result from underlying causes, such as post-traumatic injuries, brain tumors , changes in intracranial pressure(N), infections, drugs, etc.

Many systemic disorders(N) and diseases, along with their usual symptoms, can be associated with headaches. Some of these disorders(N) include hypertension , anemia(N), hypothyroidism, heart(N) disease, lung disease, high Blood Pressure , sleep disorders(N), arthritis(N), and AIDS.

The challenge of identifying the type of headache that you are suffering can be approached by understanding the history of the headache. Important features include character of pain(N) (dull, sharp, etc.), location of pain(N), temporal aspect of pain(N) (time of day, duration), associated factors, environmental exposures, and presence or absence of neurologic symptoms (numbness, tingling, weakness, etc.). When such information about the headache is available, it will point toward a particular type of headache that will require a specific therapy for that pain(N).

Types of Headaches and Their Symptoms

Most Primary Headaches are due to factors that trigger neurochemical changes within the nervous system.

    • ,
      •  – Recurring one-sided headaches that are sometimes accompanied by

    nausea 

vomiting, sensitivity to light, sound, throbbing

pain(N) , and blurred vision. The pain(N) experienced is usually moderate to severe in intensity, pulsates, and is aggravated by physical activity.

 

    • 2.

Cluster Headaches 

    • – Usually last about 20 minutes to 2 hours and may recur at the same time of the day. They cause

pain(N)

    •  behind one eye, and possibly redness, tearing, and

nasal congestion

    •  on the involved side. They usually are not accompanied by

nausea

    •  or photophobia, which distinguishes them from

migraine headaches

    • .

 

    • 3.

Tension-type headaches

    •  – Due to muscle tension and contraction, which can be

Stress

    •  or non- Stress related. They may last 30 minutes to 7 days, and be only mild to moderate in

pain(N)

    •  intensity, with

pain(N)

    •  in both sides of the head. Generally, no

Nausea

     or photophobia is present, and the headache is not aggravated by physical activity.

Secondary Headaches are a result of an underlying cause, including:

    • 1.

Post-traumatic injuries or concussion

    •  – headache may be accompanied by

vertigo

    •  or light-headedness, lack of energy, poor concentration and memory, or irritability.

 

    • 2.

Changes in intracranial pressure

    •  (e.g. brain hemorrhage,

subarachnoid hemorrhage

    • ). Both low and high

pressure(N)

    •  in the head may cause

pain(N) 

    • , usually on both sides of the head.

nausea

    • ,

vomiting

    • ,

Dizziness

    • , and blurred vision may accompany moderate to severe headache.

 

    • 3. Intracranial infection (e.g.

meningitis

    • ) –

pain(N)

    •  is experienced on both sides of head, due to inflamed meninges (membranes that normally cover the brain and spinal cord).

 

    • 4. Cerebrovascular disease, including infarction, brain hemorrhage (ruptured aneurysm), and arteritis (inflammation of the brain arteries or other structures in the head or neck, e.g.

temporal arteritis 

    • ). Inflammatory causes such as arteritis may be

pain(N)

    • ful; but

Stroke

    •  is usually without complaints of headache.

 

    • 5.

Brain Tumors 

    • – less than 1% of people with headaches have

brain tumors 

    • ; that is, most of the time, people with

brain tumors 

    • are without headaches. Symptoms include increased intensity of

pain(N)

    • , lack of response to analgesics, aggravation of headache due to cough or

sneezing

    • , anorexia,

nausea

    • , and

vomiting

    • .

 

    • 6.

Sinus or ear infections

    •  – localized

pain(N)

    •  to the affected area, possibly with

fever

    •  and discharge. Applying

pressure(N)

    •  to the affected sinus may cause or reproduce the

pain(N)

    • .

 

    • 7.

Licit and illicit drug use, abuse or withdrawal

    •  – a headache may occur:

 

      • a) during withdrawal, or going “cold-turkey” on substances including caffeinated beverages and

pain(N)

      •  medications;

 

      • b) after a sustained period of in-take of a specific drug, the drug becomes no longer effective and seemingly begins to contribute or worsen your headache. This is called a “Rebound headache”;

 

      • c) when there is a vasodilatation of blood vessels (increased diameter of the artery) in the brain due to the use of medications, such as nitrates, which cause a mild to moderate diffused headache.

 

    • 8. Exertion due to

exercise(N)

    • , straining, or sexual intercourse (coital headaches occur around the time of intercourse, and last from minutes to hours).

 

    • 9.

Eyestrain(P)

    • , which is associated with prolonged staring at a TV, computer screen or reading.

 

    • 10. Systemic infections (e.g.

flu 

    • ,

common cold 

    • , AIDS), which may be accompanied by headache,

fever

    • , loss of appetite, or diarrhea.

 

    • 11. Metabolic and systemic disorders (e.g.

diabetes(N)

    •  ,

thyroid disease

    • s, etc.) yield variable symptoms with organ dysfunction and lab abnormalities.

 

    • 12. Temporomandibular Joint Syndrome (TMJ) is brought on by motion of the jaw and tenderness of the joint, which may cause headache on the side affected.

 

    • 13. Neuralgias (nerve

pain(N)

    • ) and related conditions such as

shingles 

    • infection, may produce sharp

pain(N)

    •  in the head following a specific distribution of an affected nerve. Lips, gums, cheek, and chin may be affected.

 

    • 14. A headache due to

Indigestion

    • , especially stress-related

indigestion

    • , causes frontal, throbbing headaches. Relaxing or sleeping after taking antacids such as Mylanta or Maalox can relieve it. Massaging the stomach area, or putting a hot pack on the abdomen also will relieve the

indigestion

     , as well as the headache.

 

Cause

A headache occurs when nociceptors, or pain(N) sensing nerve endings, are triggered by Stress, muscular tension, or the dilation of blood vessels. The areas of the head that contain nociceptors are the scalp, face, mouth, throat, muscles of the head, and blood vessels at the base of the brain. The bones of the skull and tissues of the brain do not contain nociceptors.

Nociceptors transmit a message to the deep structures of the brain, which receives the signal and detects where the pain(N) has originated. Involved in this pathway of signal transmission are many chemicals known as neurotransmitters, which include epinephrine, serotonin, histamine, gamma-aminobutyric acid (GABA), glutamate, beta-endorphin, enkephalin, substance P, bradykinin, neuropeptide Y, dopamine, acetylcholine, norepinephrine, and many others. Many scientists believe that most headaches occur due to the alteration in levels and functioning of some of these chemicals.

More recent theories suggest that some headaches, particularly migraines , may occur when blood vessels overreact to various triggers, such as a certain foods or beverages, bright lights, odors, anxiety, or weather changes. This causes spasms that close and severely constrict several arteries supplying oxygen-rich blood to the brain and the areas nearby. As the arteries narrow, blood clotting(N) elements, such as platelets, clump together – a process that is believed to release serotonin (a brain neurotransmitter).

Serotonin acts as a powerful constrictor of arteries, further reducing the blood supply to the brain. In response to this reduction of oxygen-rich blood, other arteries within the brain dilate (open wider) to meet the brain’s required oxygen and energy levels. The dilation of arteries leads to the release of pain-producing substances called prostaglandins and other chemicals that cause inflammation and swelling, and increase sensitivity to pain(N) by stimulating the nociceptors. This vicious cycle of events results in a headache and other symptoms associated with migraines and, potentially, other types of headaches.

How the diagnosis is made

Most headaches are diagnosed and treated without diagnostic tests or a specialist. Generally, a history and physical exam point to the right diagnosis. Some persistent and enigmatic headaches may require neurological imaging, such as MRI and or neurological consultation.

The assessment of a headache sufferer should start with the physician taking a complete history of the patient’s condition. It should include when the headache occurs, where they occur, how often, what aggravates and what retriggers them. Identifying the trigger factors may be helpful in treating and preventing further attacks.

Examples of some triggers are:

  • Emotional: family problems, work related problems, career changes, anticipation , anxiety.
  • Stress: strenuous physical exercise(N) or work, illness, too much or too little sleep.
  • Environmental: bright lights, perfume, tobacco, loud noises, changes in altitude, weather, or barometric pressure changes.
  • Chemical: menstrual changes, low blood sugar.
  • Medication use
  • Food and beverages: hard cheese(N), hot dogs, chocolate, nuts, food additives such as monosodium glutamate, wheat, sugar, or milk products.
  • Digestion problems

The evaluation then continues with a very thorough neurological exam and a detailed examination of the head and neck including scalp, blood vessels, eyes, ears, sinuses, temporomandibular joint, teeth, and the bones and muscles of the neck, shoulders and upper back.

If a diagnosis is uncertain, a number of tests can be useful, such as:

  • Blood tests – may include a complete blood count; a reading for levels of electrolytes, sodium, chloride, bicarbonate, potassium including calcium magnesium, and liver enzymes; an analysis of kidney(N) functions (BUN, creatinine levels); and the erythrocyte sedimentation rate.
  • Imaging tests – cervical spine X-Rays, sinus X-Rays, head CT scan, and head and neck MRI may be performed if necessary.
  • Lumbar puncture and electroencephalography, only if necessary.

Treatment

Treatment depends on the type and severity of the headache and includes a wide variety of medicines ranging from mild over-the-counter painkillers (e.g. Aspirin, Tylenol, Excedrin, Advil, Ibuprofen, Naproxen, etc.) to stronger narcotic opiate painkillers (Codeine, Morphine, Demerol), “tryptans” such as Imitrex for Migraines, and seizure medications (Valporic Acid). See treatments for specific headache.

Other treatments include:

  • oxygen therapy.
  • Antihypertensive medications such as beta-blockers, calcium channel blockers
  • Sleep hygiene
    Alternative therapies, such as chiropractic manipulation, massage, acupuncture, mind-body therapy, aromatherapy (e.g. peppermint oil extract), herbal remedies (e.g. fever few for migraines; guarana, ginger, gingko or valerian root for milder headaches).
  • Behavioral therapies, including Biofeedback, guided imagery, relaxation and Stress reduction training.
  • Nutritional therapies (e.g. use of minerals and vitamins, including Magnesium, riboflavin, vitamin B2, etc.).
  • Physical approaches, such as regular and frequent aerobic exercise(N).
  • dietary changes (avoid triggering factors such as chocolate, processed foods, alcohol(N)).
  • surgical options in refractory cases.

Similar Conditions